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TRACHEA
ANDESOPHAGUS
Jeriel John C. Majam, MD, FPSOHNS
Otorhinolaryngology Head and Neck Surgery
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TRACHEA
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ANATOMY
Extends from C6 T5/6 vertebrae
Nearly cylindrical, slightly flattenedposteriorly
16-20 rings or C-shaped bars,incomplete posteriorly
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ANATOMY
Supplied mainly by the inferior thyroidarteries
Receives branches from the superiorthyroid, bronchial, and internal thoracicarteries
Drained by the inferior thyroid vein
Innervated by the vagus, sympathetic,and recurrent laryngeal nerves
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CONGENITAL DISORDERS
Tracheal Agenesis or Atresia
Rare
There is no continuity between thelarynx and trachea
Fatal
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CONGENITAL DISORDERS
Tracheal Webs
Thin band of tissue spanning thetracheal lumen without deformity ofthe underlying cartilage
Tx: Dilation, laser transection;resection and anastomosis
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CONGENITAL DISORDERS
Tracheal Stenosis Assoc tracheoesophageal fistula,
pulmonary hypoplasia, vascular sling,
Trisomy 21 Cartilage is smaller and nonflexible, lacks
the posterior membranous portion
Dx: endoscopic evaluation
Tx: resection and reanatomosis,tracheoplasty
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CONGENITAL DISORDERS
Tracheomalacia Weakness of the tracheal wall resulting
in marked exaggeration of movement
with respiration Symptoms:
Expiratory stridor, wheezing
Barking cough Hyperextension of neck
Reflex apnea
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CONGENITAL DISORDERS
Primary Tracheomalacia
Esp in premature infants
Dx with rigid endoscopyshowing widened posterior
wall with expiratory collapse Resolves 18-24 months
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CONGENITAL DISORDERS
Secondary Tracheomalacia
After surgical repair of
tracheoesophageal fistula External compression from
vascular anomalies
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CONGENITAL DISORDERS
1/3000
livebirths
Drooling,
coughing,cyanosis,
abdominal
distention,
poor feeding
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Clinical Considerations
Foreign body aspiration
More likely to enter right bronchus
Tracheoscopy/bronchoscopy
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Ventilating Bronchoscope
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TRACHEOSTOMY
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Tracheostomy
Is an opening surgically created
through the neck into the trachea
through which air may pass to the
lungs, by-passing through the
upper airway.
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Tracheostomy
Incidence (2002 PGH)
107 referrals 85% adults
Pneumonia and CVD
65 ENT ward tracheostomies Laryngeal masses
Oral cavity tumors
Anterior neck masses
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BACTERIAL TRACHEITIS
Membranous laryngotracheobronchitis Antibiotis directed vs Staph aureus and H.
influenza
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From cricoid cartilage (C6) to stomach(T10)
3 constrictions CricopharyngeusArch of the aorta & left main bronchus Gastro-esophageal junction
ESOPHAGUS
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ESOPHAGUS
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Blood supply inf. thyroid br. of thyrocervical trunk
small br. of thoracic aorta
bronchial aa.
ascending br. of left gastric a
ascending br. of left phrenic a.
Venous drainage Inf thyroid
Azygos, hemiazygos
Gastric
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ANATOMY
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Layers: Outer longitudinal muscle
Inner circular muscle
Submucosa Mucosa
Upper 1/3 skeletal muscle, distalportion is smooth muscle
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ANATOMY
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Gastroesophageal reflux 50% of infants; pathologic if it persists
beyond 18 months of age
Vomiting soon after or up to several hoursafter feeding
Dx: prolonged esophageal pH monitoring
Tx: positioning, dietary changes
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Congenital
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This Is A Piggy Bank
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This Is A Human Piggy Bank
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For Practice
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Structural: DIVERTICULA
Caused in part by an area of anatomic weakness3 areas of constriction Killians dehiscence
Between cricothyroid & cricopharyngeus mm
Laimer-Haeckerman space Between cricopharyngeus & circular fibers of esophagus
Killian-Jamieson space Lateral dehiscence bet. cricopharyngeus & esophageal muscle
fibers through recurrent laryngeal n passes
TRACHEA AND ESOPHAGUS by JERIEL JOHN C. MAJAM, MD, FPSOHNS
The only esophageal problem in ENT is laryngopharyngeal reflux (MC)
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Structural: ZENKERS DIVERTICULUM
Zenkers diverticulum (MC)
Barium swallow simply xray
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Due to chronic spasm of the upper
esophageal sphincter with resultant
high pressures in Killiansdehiscence
80% of all diverticula (MC)
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Structural: ZENKERS DIVERTICULUM
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Symptoms
Dysphagia (MC)
Spontaneous regurgitation ofundigested food
Aspiration & cough
Halitosis
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Structural: ZENKERS DIVERTICULUM
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Diagnosis
Barium swallow
Esophagoscopy (flexible is recommended)
Treatment
Surgery
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Structural: ZENKERS DIVERTICULUM
Rigid esophagoscopy removal of foreign body, usually used by ENT
Flexible esophagoscopy usually used by enterologist
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Barium Swallow
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AP View
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Barium Swallow
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Structural: ACHALASIA
Zonal reduction inganglion cells
Esophageal aperistalsisand LES dysfxn
Xray: absent primaryperistalsis, beak-liketapering at theesophageal hiatus
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Structural: DIFFUSE ESOPHAGEAL SPASM
Intermittent abn esophageal motility
Manometry: presence ofsimultaneous contractions andintermittent N primary peristalsis
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Can be diagnosed through manometry
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Xray: absence ofprimary
peristalsis in thesmooth muscleportion,corkscrewappearance
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Structural: DIFFUSE ESOPHAGEAL SPASM
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Structural: PRESBYESOPHAGUS
Abnormal motility associated with aging
Decreased primary and increased
tertiary contractions
Rule out other concomitant illnesses
first
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Structural: SCLERODERMA
Aperistalsis of the lower 2/3 of theesophagus
Marked decrease in lower esophagealsphincter pressure
Normal peristalsis in the upperesophagus
60% with symptomatic dysphagia
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Structural: SCLERODERMA
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Structural: POLYMYOSITIS
Muscle weakness secondary toinflammation and degenerative changes
in striated muscle
Peristalsis is diminished and poorlydiminished
Esophagus may be dilated
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Affects lower esophagus
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Structural: HIATAL HERNIA
Portion ofstomach
passing throughthe normalesophagealhiatus abovethe diaphragm
Normally associated with obesity, pregnancy etc
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Obesity
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Structural: REFLUX ESOPHAGITIS
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Structural: STRICTURES
Caustic ingestion - common
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Structural: SCHATZKIS RING
Concentric ring at the gastro-esophageal
junction
6-14% of routine barium swallows
Only 1/3 are symptomatic
Dysphagia if lumen < 13 mm
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Schatzkis Ring
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Structural: ESOPHAGEAL WEBS
Aberrant structure consisting of squamous
mucosa located anywhere along the
esophagus
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Easy to treat
Dilate
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Structural: ESOPHAGEAL WEBS
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Others: BOERHAAVE SYNDROME
Results from a tear through all layers of
the esophageal wall just above the
diaphragm produced by a sudden
increase in esophageal pressure
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Others: MALLORY-WEISS SYNDROME
Manifest by bleeding from lacerations of
the cardia of the stomach as a result of
prolonged or forceful vomiting
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Most common benign tumor
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LEIOMYOMAMost common benign tumor
L side smooth border
R sight irregular border
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Inflammatory: PLUMMER-VINSON
Iron deficientanemia, upper
esophageal web,
hypothyroidism,glossitis, gastritis,
dysphagia
15% increaseincidence of
postcricoid SCCA
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Inflammatory: BARRETTS ESOPHAGUS
Lower portion of esophagus is lined withcolumnar rather than squamous
epithelium
Progresses to adenoCA of esophagus in10-15%
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ESOPHAGEAL CANCER
4% of cancer deaths
Male:female = 5:1
Chronic tobacco &alcohol use
Lower 1/3 of
esophagus 40-50%
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ESOPHAGEAL CANCER
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Fungating in appearance
Predisposing alcohol and smoking
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